tbuckley/cabot-search huggingface dataset:
Abstract P378: Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity (EPIPHANY) Study: A Cluster Randomized Trial
Authors: Shakia T Hardy, Lanisha Hall, Lonnie Hannon, Andrea Cherrington
Journal: Circulation (2023)

Introduction: High rates of hypertension and poverty in the rural South contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults. Clinical trials have shown that lifestyle interventions like the Dietary Approaches to Stop Hypertension diet and increasing physical activity reduce the risk for hypertension. However, suboptimal implementation indicates a need to identify mechanisms of prevention in rural populations impacted by negative social determinants of health that can make achieving healthy lifestyle behaviors more challenging. Methods and Results: The EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical activitY) Study is a cluster randomized controlled trial testing a multilevel intervention designed to reduce community and individual barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. EPIPHANY is enrolling and randomizing 20 churches in the Black Belt region of Alabama. Health education fairs offered to all churches are being used to screen and enroll Black adults with elevated BP or stage 1 hypertension (120-139 mm Hg and diastolic BP &lt;90 mm Hg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/ American Heart Association BP guideline. Participants (n=240) in churches randomized to the control condition are offered access to online resources including cooking demonstrations and exercise classes. Participants (n=240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification, goal setting and problem solving; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as peer health advocates to deliver training for church members on lifestyle modification. We will employ a Type 1 Hybrid Implementation-effectiveness design to assess the effectiveness and implementation of this multi-level intervention, using the RE-AIM framework. BP, social determinants of health, psychosocial factors, physical activity and diet are being assessed. The EPIPHANY trial began recruitment in August 2022 and has enrolled 18 and 25 Black adults in the first two churches randomized to the control and intervention conditions, respectively, and recruited four churches for the next wave of screenings. Conclusion: The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support. The study could provide evidence for a feasible, scalable and sustainable approach to preventing hypertension in rural, underserved communities.
Abstract MP18: Associations of Individual and Area-Based Socioeconomic Status With Cardiovascular Outcomes and Mortality: A Prospective Cohort Study
Authors: Han Han, Geng Zong
Journal: Circulation (2023)

Introduction: Evidence is limited regarding the interactions between individual socioeconomic status (SES) and neighborhood deprivation on long-term health outcomes. We aimed to evaluate the joint impacts of individual- and area-based SES on risks of disease-specific incidence and mortality. Hypothesis: We hypothesized that neighborhood deprivation would be related to disproportionate harm on health outcomes in those of lower individual SES. Methods: Data were sourced from UK Biobank. We assessed individual SES by self-reported education attainment (college or university degree/others) and measured area-based SES by the Townsend deprivation index (in quintiles: Q1 was the least deprived and Q5 was the most deprived). Poisson regression was used to examine the associations of individual- and area-based SES with incident CVD and heart failure (HF), and mortality from all, CVD, and cancer causes. Results: During a mean follow-up of 11.9-12.3 years, we documented 24,936 incident CVD cases, 10,887 HF cases, and 36,584 deaths. Individual- and area-based SES were each significantly associated with higher risks of incident cardiovascular events and mortality. Compared with those with college/university degrees, the multivariable-adjusted relative risks (95% CIs) for less-educated participants were 1.18 (1.14, 1.21) for CVD, 1.24 (1.19, 1.30) for HF, 1.14 (1.12, 1.17) for all-cause mortality, 1.11 (1.05, 1.17) for CVD mortality, and 1.09 (1.06, 1.13) for cancer mortality. Being in the Q5 group (vs. Q1) was associated with 19-48% higher risks of health outcomes. A significant interaction between education attainment and neighborhood deprivation was found for incident CVD and HF, all-cause and cancer mortality, but not for CVD mortality (Fig1). The associations between higher deprivation and increased risks of CVD events and mortality were more prominent in less-educated subgroups. Conclusions: The detrimental impacts of neighborhood deprivation on health outcomes might be exacerbated by low education attainment.
Abstract P198: Associations Between Plasma Proteome and Leukocyte Mitochondrial DNA Copy Number: The Atherosclerosis Risk in Communities Study (ARIC)
Authors: Ethan Moser, Brian T Steffen, Jiaqi Xie, Nathan Pankratz, John Lane, Dan E Arking, Thomas Mosley, Weihua Guan, Sanaz Sedaghat, Jim S Pankow, Pamela L Lutsey, Weihong Tang
Journal: Circulation (2023)

Introduction: The number of copies of the mitochondrial genome, termed mitochondrial DNA copy number (MTCN), is a proxy for mitochondrial function and varies by cell. Critically, lower MTCN has been associated with aging and chronic diseases such as dementia and cancer. We conducted a large-scale proteomics analysis of leukocyte MTCN (L-MTCN) to elucidate pathways modulated by L-MTCN that may be involved in diseases of aging. Hypothesis: We hypothesize that L-MTCN is significantly associated to plasma proteins that have been implicated in biological pathways of L-MTCN and related diseases. Methods: Based on whole genome sequencing (WGS) data measured in samples collected in ARIC visits 1, 2, and 3 (i.e., baseline for the current study), L-MTCN was calculated as (2 * coverage of the mitochondrial genome) / coverage of the autosome, using the median coverage of 1000 base pair bins overlapping the mitochondrial genome (16 total) and the median coverage of ~142,000 higher quality autosomal bins. Only samples with read lengths of 150 or 151 were included in subsequent analyses, and L-MTCN estimates were inverse normalized within read length group and WGS group before being merged together. This normalized L-MTCN was then analyzed as a predictor for an association with 4,870 plasma proteins measured by SOMAscan v4 in ARIC visit 3 in race-specific generalized linear models, adjusting for the following covariates at baseline: WGS sample visit, age, gender, field center, smoking status, and a measure of kidney function. Bonferroni correction was applied to account for the number of proteins tested in 5,007 White participants (p≤1x10 -5 ). Associations were tested for replication in 1,178 Black participants and considered significant if protein estimates had the same direction of association as Whites at p-value ≤ 2.2x10 -4 . Results: Among White participants, 230 proteins were significantly associated with L-MTCN. Of these proteins S100A9, GP1Bα, EGFR, THBS2, and FCGR3B were significantly replicated among Black participants. Strongest associations with L-MTCN were seen with GP1Bα (Estimate: 0.121) and S100A9 (Estimate: -0.191). Biologically S100A9 is a calgranulin and together with S100A8 forms calprotectin, which have roles mediating inflammatory processes. GP1Bα helps mediate platelet activation and forms the glycoprotein Ib-IX-V complex which acts as a platelet surface receptor for von Willebrand factor facilitating platelet adhesion. Conclusion: This large proteomics analysis identified 230 plasma proteins significantly associated with L-MTCN. Some of the proteins have been connected to inflammatory diseases, cardiovascular disease, and cancer in the literature. These results provide insight into proteins involved in biological pathways related to L-MTCN.
Abstract P568: Osteoporosis and Cardiovascular Disease-Related Mortality Trends in the United States, 1999 - 2020
Authors: Ramzi Ibrahim, Abdulla Alabagi, Mohammed Salih, Adam Habib, Vikram Singh, Simar Singh, Soumiya Ravi, Justin Z Lee
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD) and osteoporosis share common risk factors and often co-exist. In this study, we quantify CVD-related mortality trends in individuals with osteoporosis. Hypothesis: Among gender, racial, and geographic subgroups, disproportionate mortality rates related to CVD and osteoporosis are observed. Methods: We performed cross-sectional analyses using the CDC Wide-Ranging Online Data for Epidemiologic Research database to identify mortality rates from 1999 to 2020 with CVD as the underlying cause of death and osteoporosis within the multiple causes of death. Quantified measures included age-adjusted mortality rate (AAMR), average annual percentage change (AAPC), and 95% confidence intervals. Joinpoint regression (National Cancer Institute) was used for AAPC calculation. Stata (StataCorp LLC) was used for data visualization. Results: There was a total of 70,930 deaths from 1999 to 2020. The AAMR decreased from 1.76 in 1999 to 0.40 in 2020 [p &lt;0.05] with an AAPC of -6.8%. There were a higher AAMR among females (1.34) compared to males (0.27) [p &lt;0.05], with a similar AAPC (-6.6% and -7.2%, respectively [p &gt;0.05]). White populations had the highest AAMR, followed by Asian populations (0.63), then Black populations (0.28) [p &lt;0.05]. AAPC was similar among the three racial subgroups (-6.9%, -6.8%, -4.7%, respectively [p &gt;0.05]). Non-Hispanic (0.98) subgroups had higher AAMR than Hispanic subgroups (0.45) [p &lt;0.05], with a similar AAPC (-6.8% and -6.6%, respectively [p &gt;0.05]). Non-metro regions (1.17) had higher AAMR compared to metro regions (0.9) [p &lt;0.05], with a similar AAPC (-5.8% and -7.2%, respectively [p &gt;0.05]). The Midwest (1.19) had the highest AAMR, followed by the West (1.13), South (0.80), and the Northeast (0.74) [p &lt;0.05]. AAPC was similar among all US regions (-6.4%, -6.6%, -8.3%, and -6.4%, respectively [p &gt;0.05]). Conclusion: Disparities related to CVD and osteoporosis related mortality exist among gender, racial, and geographic subgroups within the United States.
Abstract P221: Intake of Ultra-Processed Foods in Relation to Cardiovascular Disease Incidence in US Men and Women With Diabetes Mellitus
Authors: Zhangling Chen, Jean-Philippe Drouin-chartier, Neha Khandpur, Yang Hu, Sinara Rossato, Joann E Manson, Eric B Rimm, Frank Hu, Qi Sun
Journal: Circulation (2023)

Introduction: Recent evidence suggests that intake of ultra-processed foods (UPF) is related to unfavorable cardio-metabolic risk profiles among generally healthy populations. However, evidence on the relationship between UPF intake and cardiovascular disease (CVD) among patients with type 2 diabetes (T2D) is lacking. Hypothesis: We assessed the hypothesis that higher intake of dietary UPF is associated with higher risks of CVD among individuals with T2D. Methods: We prospectively followed 13,272 men and women participating in the Health Professionals Follow-Up Study (HPFS) and Nurses’ Health Study (NHS) with T2D at baseline and during follow-up (HPFS: 1986-2018; NHS: 1980-2014). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 years. UPF were categorized according to the Nova classification. CVD was defined as fatal and non-fatal coronary heart disease (CHD) (including nonfatal myocardial infarction, coronary artery bypass graft surgery, and coronary angioplasty and stent) and fatal and non-fatal stroke. Associations of UPF consumption with risks of CVD were assessed using Cox regression. Results: During 165,761 person-years of follow-up, 1,826 total CHD and 529 total stroke were identified and confirmed. After adjusting for demographics, lifestyle, medical history, dietary factors, and diabetes medication use, higher total intake of UPF was associated with higher risk of CHD. The multivariable-adjusted HRs (95% CIs) were 1.20 (1.02, 1.43) ( P trend = 0.03) when comparing the highest and lowest quintiles (Q5 vs. Q1) or 1.03 (1.01, 1.04) for each 1 serving/day increment of UPF. No association between UPF intake and risk of stroke was observed (Q5 vs. Q1: 0.92 (0.67, 1.24)). These results were consistent across subgroups in analyses stratified by age, sex, BMI, diet quality, physical activity, smoking, diabetes medication use, or diabetes duration. In addition, compared with participants who had a stable or decreased consumption of UPF (≤0 change in UPF) from pre- to post-diabetes diagnosis, participants who increased consumption of UPF (&gt;0 increment of UPF intake) after diabetes diagnosis had a 15% (1%, 31%) higher risk of CHD. Conclusions: Among participants with T2D, higher dietary UPF consumption was associated with a higher risk of CHD, but not stroke. These results provide further support for the current recommendations to limit UPF consumption for the prevention of CHD among patients with diabetes.
Abstract P463: E-cigarette Use and Seeking Professional Help for Depression Among Young Adults: Evidence From the VapeScan Study
Authors: Justin Liu, Dona Sangapalaarachchi, Chloe Fang, Maria Cepeda, Nancy LoIacono, Siyue Gao, Vesna Ilievski, Diane Hawkins, Daichi Shimbo, Elizabeth Oelsner, Ana Navas-Acien
Journal: Circulation (2023)

Introduction: E-cigarettes (e-cigs) are the most commonly used tobacco product among youth. While cigarette use has been associated with a history of depression, research on the associations of e-cig use and depressive symptoms remains limited. While other studies have looked at the incidence of depression among e-cig users, the VapeScan study also factors in dual users who both smoke cigarettes and e-cigarettes. Hypothesis: We hypothesized that e-cig use is associated with seeking professional help for depression among young adult participants in the VapeScan Study. Methods: Participants aged 18 to 50 years were recruited from the greater New York area to participate in the VapeScan Study from May 2021 to October 2022. Participants were classified as exclusive current e-cig users (e-cig users), current e-cig and former cigarette users, current e-cig and cigarette users (dual users), or non-users of both e-cigs and cigarettes (controls); former vapers and exclusive cigarette users were excluded from the study. Participants self-reported if they had ever “seen a doctor or other health professional for depression.” Rates of professional care for depression were compared by logistic regression test. Logistic regression was used to test the association between e-cig use status and seeking professional help for depression, adjusted for age, sex, and race/ethnicity. Results: Among 147 participants, mean (SD) age was 28 (8) years, 54.42% (80 of 147) of participants were assigned female at birth, 36.73% (54 of 147) were Non-Hispanic White (ETC). There were 29 e-cig users, 42 dual users, and 76 controls. Forty-one percent of e-cig users (12 of 29) had seen a health professional for depression versus 64% (27 of 42) of dual users and 29% (22 of 76) of controls (p-value=0.0014). After adjustment, compared to controls, e-cig users were 1.66 times more likely to have sought professional care for depression (95%CI: 0.59-4.71) and dual users were 7.90 times more likely (95%CI: 2.99-20.88). Conclusions: E-cig use, and particularly dual use of e-cigs and cigarettes, was associated with having sought professional help for depression among young adults. Persons presenting with depressive symptoms should be screened for tobacco product use, and vice versa, to ensure provision of evidence-based mental health and tobacco cessation programs.
Abstract P436: Objective Physical Activity and Orthostatic Hypotension in Older Adults: The STURDY Trial
Authors: Sohyeon Kwon, Stephen P Juraschek, Amal A Wanigatunga, Christine M Mitchell, Erin D Michos, Edgar R Miller, Lawrence J Appel, Jennifer A Schrack
Journal: Circulation (2023)

Introduction: Orthostatic hypotension (OH) is prevalent in older adults and associated with poor health outcomes. Physical activity (PA) may attenuate the risk of OH, but evidence of the association between daily volume and patterns of objectively measured PA and OH is lacking. Hypothesis: Lower daily volume and higher fragmentation of PA are associated with greater risk of OH. Methods: We included 196 participants (age ≥70) of the Study To Understand Fall Reduction and Vitamin D in You (STURDY) trial who wore an accelerometer for 7 days at their baseline visit and completed a supine-to-standing OH assessment at 2-year follow-up. We defined OH as a 20 mm Hg drop in systolic blood pressure or 10 mm Hg drop in diastolic blood pressure 3 minutes after changing from supine to standing position. Using accelerometry, daily total activity counts (TAC; counts/day) and time spent active (mins/day) were used to measure volume of daily PA. Active-to-sedentary transition probability (ASTP) was calculated as the reciprocal of the average PA bout duration to measure PA fragmentation. Multivariable robust Poisson regression estimated the risk ratio between baseline PA and OH after 2-years of follow up. Results: Among 196 participants, 12.2% of participants had OH after 2-years of follow up; 62.2% were male, and mean baseline age was 76.4 (SD=5.2). In this prospective analyses, lower daily activity (lowest vs highest tertile of TAC: RR = 6.49, 95% CI: 2.15-19.58; lowest vs highest tertile of time spent active: RR= 4.30, 95% CI:1.55-11.92) and higher fragmentation (highest vs lowest tertile of ASTP: RR = 5.36, 95% CI: 1.57-18.34) of PA were associated with higher risk of OH after 2 years (Figure) . Conclusions: Both lower daily activity volume and higher fragmentation of PA were associated with increased risk of OH in older adults over follow-up. Longitudinal studies to assess whether changes in PA volume or fragmentation alter the risk of OH should be explored.
Abstract P431: Comparative Safety and Effectiveness of Direct Oral Anticoagulants versus Warfarin in Patients With Non-Valvular Atrial Fibrillation and Severe Chronic Kidney Disease
Authors: Yunwen Xu, Shoshana Ballew, Alex R Chang, Lesley Inker, Morgan Grams, Jung-Im Shin
Journal: Circulation (2023)

Background: Landmark trials of direct oral anticoagulants (DOACs) versus warfarin for non-valvular atrial fibrillation (NVAF) excluded patients with severe chronic kidney disease (CKD). Real-world data on safety and effectiveness of DOACs in severe CKD is limited. Methods: New users of DOACs (apixaban, rivaroxaban, and dabigatran) or warfarin with NVAF and severe CKD between 2010 and 2020 were identified using the de-identified electronic health records form the Optum Labs Data Warehouse. We estimated the risks of bleeding, ischemic stroke, and death for apixaban and rivaroxaban separately (vs. warfarin) using Cox regression models. Incidence rate (IR) and hazard ratio (HR) were adjusted for baseline characteristics by inverse probability of treatment weighting (IPTW). Dabigatran users were not included for the analysis due to small sample size (n=318). Results: Compared with warfarin users (n=7548), apixaban users (n=3719) were older (mean age 77 vs. 76 years) and had more hypertension (94% vs. 90%). In IPTW analysis, apixaban was associated with a lower risk of any bleeding (HR [95% CI], 0.71 [0.56, 0.89]), as well as major bleeding (HR [95% CI], 0.61 [0.46, 0.81]). There were no significant differences in ischemic stroke and death between apixaban and warfarin users ( Figure A ). Rivaroxaban users (n=920) were older (mean age 76 vs. 75 years) and had higher estimated glomerular filtration rate than warfarin users (mean: 25 vs. 23 ml/min/1.73 m 2 ). In IPTW analysis, risks of bleeding were higher among rivaroxaban users than warfarin users (any bleeding: HR [95% CI], 1.43 [1.05, 1.95]; major bleeding: HR [95% CI], 1.54 [1.09, 2.17]), with no significant differences in ischemic stroke and death ( Figure B ). Conclusion: Apixaban was associated with a lower risk of bleeding, but rivaroxaban was associated with a higher risk of bleeding, compared with warfarin in patients with NVAF and severe CKD. Risks of ischemic stroke and death were similar between agents. Apixaban may be a preferable oral anticoagulant in this population.
Abstract P542: Classifying COVID-19 Related Hospitalizations and Deaths in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study
Authors: Akshaya Krishnaswamy, Tauqeer Ali, Alex Arynchyn, Harry Chang, Lucas Chen, Mitchell Elkind, Carmen R Isasi, Lauren Jager, Ling Jin, Maureen R Kelly, Anna Kucharska-Newton, Victor E Ortega, Ashmi A Patel, Lisa Reeves, Kimberly B Ring, Cheryl Tarlton, Janis Tse, Elman Urbina, Maya Vankineni, Sally E Morganroth, Jihyun Yang, Ying Zhang, Wendy S Post, Elizabeth C Oelsner
Journal: Circulation (2023)

Objectives: Administrative criteria are often used to define COVID-19 outcomes despite challenges in differentiating hospitalization “for” vs “with” COVID-19 and unknown reliability for identifying COVID-related cardiopulmonary complications. We implemented a protocol to adjudicate COVID-related events across 14 studies participating in C4R. Methods: C4R cohorts ascertained COVID-related hospitalizations and deaths via questionnaires or ongoing surveillance. Medical records were reviewed by C4R physicians using a standardized protocol to assign COVID-related diagnoses as definite or probable. C4R diagnoses were compared against ICD codes assigned to the events. This report includes data from events centrally adjudicated by C4R as of September 2022. Results: Among 144 events ascertained across 7 cohorts as potentially COVID-related, SARS-CoV-2 infection was confirmed in 107/117 (91%) non-fatal hospitalizations and 26/27 (96%) deaths. Of confirmed infections, COVID-19 illness was diagnosed as the cause of 101/107 (94%) hospitalizations and 24/26 (92%) deaths ( Table ). Of non-fatal hospitalizations with infection, 72% were diagnosed with severe or critical COVID-19, 78% with COVID-associated pneumonia, and 29% with renal failure; other complications were less common. C4R review did not validate diagnoses indicated by ICD codes for 1 COVID-19 infection, 5 pneumonias, 1 stroke, and 7 renal failure cases. C4R review did identify diagnoses that were not ICD-coded for 13 infections, 31 pneumonias, 6 myocardial infarctions, 5 venous thromboses, and 21 renal failure cases. Conclusions: Protocolized medical records review by C4R confirmed COVID-19 as the cause of hospitalization or death in 87% of events ascertained as potentially COVID-related and 94% of those in which SARS-CoV-2 infection was confirmed. Both false-positive and false-negative misclassification by ICD criteria was observed. Protocolized review may be useful to identify and validate COVID-related events for epidemiologic research.